mental health

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Bringing together physical and mental health 1 2 3 4 5 6 7 £13 billion of NHS spending in England is linked to co-morbid mental health problems among people with long-term conditions (Naylor et al 2012). Co-morbid mental health problems also have wider economic costs as a result of lower employment rates and productivity (Hutter et al 2010). What would a more integrated approach look like? People with long-term physical health conditions would receive support for the psychological aspects of their condition as a standard part of their care. This would include: routinely providing psychological education and support as part of cardiac and pulmonary rehabilitation and other self-management programmes; making full use of peer support groups (locally or online); and embedding clinical psychologists within multidisciplinary teams to allow skills transfer in both directions. Active case-finding would be used to identify people at greatest risk, in line with guidelines from the National Institute for Health and Care Excellence (NICE 2010). Integrated approaches involving close working between primary care and other professionals – for example, based on the collaborative care model (see Section 4) – would be available for people with co-morbid depression or anxiety (Coventry et al 2015; Rosenberg et al 2014; Sharpe et al 2014). The most complex patients with multiple conditions would not be referred to generic psychology services, but would be supported by professionals skilled in working at the interface between physical and mental health. Further guidance •• Investing in emotional and psychological wellbeing for patients with longterm conditions. A guide to service design and productivity improvement for commissioners, clinicians and managers in primary care, secondary care and mental health (NHS Confederation 2012) •• London’s care pathway for diabetes: commissioning recommendations for psychological support (London Strategic Clinical Networks 2014b) Case study examples •• 3 Dimensions of care for Diabetes (Appendix A) •• LIFT Psychology in Swindon (Appendix F) The case for change: 10 areas where integration is needed most 31
Bringing together physical and mental health 1 2 3 4 5 6 7 Priority 6: Supporting the mental health and wellbeing of carers The problem More than 6 million people in the UK provide informal care to someone with a health condition or disability. For many, doing so can have a significant impact on their own mental health and wellbeing. In comparison with the general population, people with substantial caring responsibilities have higher levels of stress and depression and lower levels of subjective wellbeing, as well as poorer physical health (Cormac and Tihanyi 2006). In some situations – particularly in the context of palliative care – supporting the mental health and wellbeing of carers is an explicit part of a patient’s care plan. However, this is often not the case, and in general carers are provided with limited support. For example, two-thirds of carers responding to one survey reported that staff had not directed them to relevant sources of information or advice (NHS Improving Quality 2014). Impact on people Survey data illustrates the toll that caring responsibilities can take on mental health and wellbeing. More than 9 out of 10 carers report that caring has a negative impact on their mental health, including stress and depression (Carers UK 2013), while 75 per cent of carers said it was hard to maintain social relationships (Carers UK 2014). This in turn can affect their ability to provide care and lead to the admission of the person they are caring for to hospital or residential care (Department of Health 2012). Health impacts are often exacerbated by carers being unable to find time for medical check-ups or treatment (Carers UK 2012). Impact on the health system The health and care system is highly dependent on informal care provided by family and friends. The value of this care is estimated to be around £119 billion per year – more than total spending on the NHS (Buckner and Yeandle 2011). Neglecting to look after the mental health and wellbeing of people making this significant contribution to the system risks adding to the burden of work conducted in the formal sector. The case for change: 10 areas where integration is needed most 32
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Bringing together mental and physic
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